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Making the Case for Enterprise Clinical Data Integration

05/11/2021

Tom Gaither
Vice President of Marketing

In a recent AHIP webinar, Terry Boch, Diameter Health’s Chief Commercial Officer, moderated a discussion with Darren Schulte, MD, President of Advanced Technology at Centene Corporation and Mike Baillie, Senior Vice President of Business Development at UnitedHealth Group (you can view the complete video here).

Terry, Darren and Mike shared their experience and insights on three primary topics during the session: 1) How to build a winning strategy: top down or bottom up?  2) Common organizational roadblocks and how to overcome them, and 3) Key metrics to demonstrate ROI.

The webinar audience also contributed to the session by answering three poll questions.  While not necessarily statistically significant, the answers to the poll questions reflect the same opportunities and challenges identified by the panel:

  • The volume of clinical data exchanged in the US is growing at a rapid rate, but most payers report exchanging data with a small percentage of their providers due to lack of shared incentives
  • While an Enterprise clinical data strategy is necessarily a top-down initiative, the justification for the strategy is built one use case at a time
  • Where use cases are supported by solid economics (i.e., ROI) organizational roadblocks and budget restrictions tend to be reduced

Poll #1: From what % of your providers are you currently collecting clinical data?

Consistent with other research and our experience, less than a quarter of responders reported that they receive clinical data from more than 50% of their providers.

In an interesting contrast to the poll results, Terry noted that estimates of the total volume of digital clinical data exchanged since 2010 in the US has exploded from near zero into the billions

“Given what we’re seeing in the industry from a clinical document exchange perspective, data is being shared at unprecedented levels.

Poll #2: What use cases are your greatest priorities for using clinical data?

If you’re responsible for clinical data integration, Mike and Darren both underscore the underlying challenge: clinical data integration requires an Enterprise focus justified by the economics of discrete use cases from across the Enterprise.  Mike also suggests that shared incentives between Payers and Providers (or “Value Based Contracting”) will increase clinical data sharing between payers and providers

“Instead of “value-based care,” I say “value-based contracting.” How do you create agreements with your providers where there are shared incentives around reducing the total cost of care through things like HEDIS and (other) programs… that motivate the provider and payer to bidirectionally exchange data?”

Darren explains his approach to “connect once, and use many” by focusing on high value use cases like Risk Adjustment and HEDIS reporting (the audience agreed; these are also the top two use cases reported in our poll).

“We take this approach where we connect once and use many, many times.  But you need that use case that enables you to connect once across the largest array of data sources and that use case will drive the data…that flows through the pipes.”

Darren also walks through the Risk Adjustment use case, and details, for example, cost savings from substituting the use of digital charts for manual chart pulls and improved revenue opportunities in Medicare Advantage programs from more accurate risk adjustment through the use of clinical data.

“ROI follows the business case you’re trying to further using the data strategies and it starts with the baseline … how this data liquidity will enable you to reduce your cost of operations, reduce your cost of care, (and) or improve the care being delivered, as it ties to the use case.”

Poll #3: What are the greatest obstacles to successfully pursuing an enterprise clinical data strategy?

Notice that only a small percentage of those responding cite “lack of clinical data” as a major obstacle to their enterprise data strategy, yet our first poll indicated most responders receive clinical data from just a minority of their providers.   One conclusion is that when clear ROI is demonstrated, internal resources and other priorities cease to be barriers to success.

Final Insights

UnitedHealth and Centene are in the vanguard of health plans putting clinical data to Enterprise use.  The lessons they learned along the way can save others time and money:

  • Follow the money. As risk is increasingly shared between payers and providers, incentives will increase for data sharing

“Follow the money. As we shift risk to the provider from a clinical and financial risk standpoint, that enables more of a partnership… and provides the impetus for (a) strategy for integration that doesn’t rely on individual use cases.”

  • Take a pragmatic approach. Our panelists agreed that while the industry is advancing toward data standards, that’s not the case today; expect to meet the market where they are
  • Expect clinical data quality issues. Raw clinical data is not actionable without refinement

“When you get multi-modal data from various sources, we have to not only normalize the thousand different ways hemoglobin HbA1c is reflected in a data set, but also think about errors, concordance issues… (for example,) diabetes is present, but lab tests and other data don’t indicate as such. There are still a lot of EHR quality issues…

Thanks again to Darren and Mike for participating with Terry on the panel.  We are privileged to work with clients like them who are both knowledgeable and willing to share that knowledge with the community.

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